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The
consequences
of
the
war
in
Bosnia
and
Herzegovina
(from
1992.
to
1995)
are
visible
and
19
years
after
its
ending.
The
war
did
not
damage
only
with
the
ruining
and
the
destruction
of
towns
and
villages,
but
has
led
to
major
loss
of
population,
individual
and
collective
consequences
of
terrifying
traumatic
events,
weakened
and
slowed
down
economic
development
of
the
country,
directly
and
indirectly
influence
the
health
status
of
the
population
and
employment
potential.
The
aim
of
this
study
was
to
determine
analyze
the
structure
of
medical
reasons
of
changes
in
working
ability
in
the
Una-Sana
Canton
in
the
period
from
1997.
to
2010.,
and
to
determine
the
proportion
of
depressive
disorders
as
psychiatric
reasons
of
changes
in
working
ability
and
to
analyze
the
relationship
between
socio-demographic
characteristics
(gender,
age,
qualifications,
length
of
working
service,
length
of
sick
leave,
the
length
of
treatment
and
number
of
psychiatric
hospitalizations)
and
changes
in
working
ability
due
to
depressive
disorders.
The
study
is
a
longitudinal
retrospective
epidemiological
study
conducted
in
the
Una-Sana
Canton
with
analysis
of
the
medical
records
on
Department
for
medical
assessment
appeal
process
in
Biha
ć
for
a
period
from
1997.
to
2010.
Data
from
medical
records
(Findings,
ratings
and
reviews)
are
entered
in
the
Evidence
Form
for
Data
Collection
(ELPP)
which
is
constructed
for
the
purposes
of
this
study.
Data
from
ELPP
are
classified
into
three
groups:
the
socio-demographic
data
and
information
on
the
employment
status;
information
about
treatment,
finding
ratings
and
reviews
on
commission
working
ability
and
group
of
information
on
leading
diagnosis
and
concomitant
diagnoses
on
the
basis
of
which
it
was
made
a
job
capacity
assessment.
Statistical
analysis
was
performed
using
SPSS
programme
version
20.0.
With
the
analysis
of
data
obtained
in
the
determined
period,
commission
expertise
of
working
ability
was
performed
in
9004
insured
persons
of
whom
64.7%
were
male.
Change
in
working
ability
was
determined
in
5612
(62.3%),
of
which
a
total
loss
of
working
ability
was
at
71.8%
of
the
examinees.
Change
in
working
ability
was
found
in
66.4%
of
male
examinees
and
54.8%
of
female
examinees.
Leading
medical
reasons
for
the
commission
expertise,
as
well
as
change
and
loss
of
working
ability
were
circulatory
system
diseases,
mental
disorders
and
diseases
of
the
muscular
skeletal
system.
In
the
change
of
working
ability,
ratio
of
frequency
of
loss
and
impairment
of
working
ability
in
diseases
of
the
circulatory
system
is
3:1
and
with
mental
disorders
8:1.
From
mental
disorders
as
the
leading
causes
of
expertise
commission
are
depressive
disorders
(38.7%),
schizophrenia
(24.7%)
and
neurotic
and
stress-related
disorders
(20.6%).
Change
in
working
ability
due
to
mental
disorder
is
the
most
common
in
depressive
disorders
(22.1%)
and
schizophrenia
(18.9%).
Also,
the
leading
cause
of
loss
of
working
ability
is
depressive
disorders
(33.2%),
schizophrenia
and
other
psychotic
disorders
(31.8%)
and
neurotic
and
stress-related
disorders
(11.0%).
It
has
been
found
that
depression
occurs
as
an
accompanying
disorder
in
14.2%
of
cases,
and
is
usually
accompanying
disorder
in
diseases
of
the
circulatory,
skeletal
muscle
and
endocrine
diseases.
In
the
group
of
examinees
with
mental
disorders
are
more
men
(62.8%)
than
women
(37.2%),
but
in
relation
to
the
total
number
of
women
and
men
there
are
more
women
with
mental
disorders
(30.6%)
than
men
(28.4%).
In
the
change
of
working
ability
there
are
more
men
with
mental
disorders
(31.2%)
than
women
(27.1%).
In
depressive
disorders
there
were
not
found
significant
differences
in
the
number
of
commission
expertise
among
men
(42.6%)
and
women
(41.0%),
however
in
the
total
sample
of
examinees
with
mental
disorders
there
are
more
number
of
women
with
depression
disorder
(50.9%)
than
men
(49.1%).
More
men
(30.3%)
than
women
(26.8%)
had
a
change
of
working
ability,
and
without
changing
of
the
working
ability
more
women
(22.2%)
than
men
(20.6%).
The
largest
number
of
examinees
with
depressive
disorder
was
aged
50
years
and
over
(66.0%)
of
which
39.6%
involved
in
changing
of
the
working
ability.
The
average
age
of
examinees
with
depression
was
46.9
±
0.63
years,
and
the
average
age
with
the
change
in
working
ability
was
47.4
±
0.63
years.
Number
of
commission
expertise
for
depression
increases
with
respect
to
all
mental
disorders.
With
reassessment
there
is
growing
number
of
patients
with
a
change
in
working
ability
from
20.2%
in
the
first
assessment
up
to
37.0%
for
reassessment.
Mostly
there
were
patients
with
severe
depressive
episode
without
(37.9%)
and
with
psychotic
symptoms
(26.9%)
among
them
in
the
largest
number
is
determined
loss
of
working
ability
(25.5%
and
23.6%).
In
severe
depressive
episode
without
psychotic
symptoms
only
2.3%
of
examinees
had
reduced
working
ability,
while
in
severe
depressive
episode
with
psychotic
symptoms
there
was
not
reduced
working
ability.
Preserved
working
ability
had
examinees
with
mild
(89.7%)
and
moderate
depressive
episode
(16.1%).
So
the
degree
and
intensity
of
depressive
disorders
represent
predictors
of
working
disability.
At
the
commission's
expertise
approached
approximately
the
same
number
of
highly
qualified/skilled
(36.7%)
and
semi-skilled/unskilled
(35.7%)
examinees
with
depression,
and
who
significantly
take
part
in
changing
the
working
ability
(22.3%
and
17.5%).
The
average
service
life
of
examinees
who
due
to
depression
have
the
change
of
working
ability
is
14.3
±
0.76
years.
It
was
found
that
54.5%
of
examinees
at
the
time
of
commission
of
expertise
were
unemployed,
34.1%
were
on
sick
leave,
of
which
51.3%
was
on
sick
leave
with
the
length
of
over
a
year.
Change
in
working
ability
is
the
most
common
among
the
unemployed
(28.8%)
and
with
sick
leave
with
the
length
of
over
a
year
(39.2%).
Most
of
the
examinees
before
the
commission
expertise
has
treated
more
than
24
months
(35.3%)
and
participated
with
34.4%
in
changing
the
working
ability
of
which
is
determined
by
the
highest
loss
of
working
ability
(32.7%).
Most
of
those
to
whom
it
was
established
that
there
is
no
change
in
the
working
ability
were
treated
in
the
period
from
6
to
12
months
(28.0%),
of
which
8.5%
depressions
are
determined
that
disability
does
not
exist,
and
19.5%
that
testing
and
treatment
has
not
been
completed.
The
largest
number
of
examinees
referred
to
the
commission's
expertise
had
hospitalization
(80.8%)
and
at
69.6%
is
identified
changes,
and
at
49.7%
loss
of
working
ability.
In
the
loss
of
working
ability
most
are
rated
examinees
who
have
had
three
or
more
hospitalizations
(42.7%).
A
high
percentage
of
examinees
(90.2%)
stated
that
they
cannot
work
and
they
want
to
retire,
one
of
which
is
at
60.9%
is
identified
changes
in
working
ability
(ratio
of
loss
and
reduced
working
ability
is
8:
1).
In
the
analyzed
period
it
is
evident
an
increased
number
of
commission
expertise,
where
mental
disorders,
diseases
of
the
circulatory
system
are
the
leading
medical
reason
for
the
change
of
working
ability.
Depressive
disorders
are
the
most
common
psychiatric
reason
for
changing
of
working
ability.
The
socio-demographic
characteristics
are
correlated
with
the
change
of
working
ability
due
to
depressive
disorder.